This 42 year old man was diagnosed with squamous cell carcinoma of the tongue. He was treated with chemotherapy and both external beam and interstitial radiation therapy. He developed an osteoradionecrosis of the left mandible. The necrotic bone was ressected and a vascularized fibular flap was used to reconstruct the mandible.
To provide the patient with a mandibular prosthesis, osseointegrated implants were placed into the reconstructed mandible. The implants had to be placed into both native mandible and the vascularized fibula. As the native mandible had been in the field of radiation therapy, 20 hyperbaric treatments were provided prior to implant placement and immediately after implant placement a further 10 treatments were undertaken. The hyperbaric treatment consisted of 90 minutes at 2.5 atmospheres absolute once a day.
The reconstructed mandible, showing oseointegrated implants in both native mandible and vascularized fibula. Endodontic treatment together with posts and cores were used to support an overdenture in the maxilla.
The bar superstructure used to retain the mandibular prosthesis.
Anterior view of the completed mandibular and maxillary prosthesis. The prosthesis has been in function for almost three years without major incident.